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Wednesday, January 27, 2016

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I really wanted to write 'Hope-Less' because 'Hopeless' makes you immediately think that the person in front of you is a complete idiot. Whereas 'Hope-Less' suggests that they are devoid of nearly all coping mechanisms and have forgotten what hope really is. And believe me, that is a truly tragic state - especially when you see that lost look in a young kid's eyes.

It's vital we break the circle of despair

Otherwise we consign the next generation, and then the next generation to repeating the mistakes of their parent(s).

Most people are ignorant of what it's like to be in a situation where there is no job, your boyfriend has left you with 2 toddlers and run off with his ice addicted new partner. That your parents separated when you were young and you haven't heard of your father since. Or that your Mum's around, but what with the price of "smokes" and what's left of the pension going on rent, food and medicines "she's not much help". And your so-called friends all smoke, most take drugs and most of them are pretty "hopeless" too. Yeah, you'd like to get away and make a new start but where do you go?

Believe me, in some areas of all countries that is the constant story seen by family GPs. That, and those who are on sickness benefits because of bad backs/depression/chronic pain ...who attend your surgery like a flock of worn out folk and each and every one of them looking 20 years older than they really are. Even the infants in their prams look confused at the behavior of the person who's wheeled them in on that particular day.

Checking out their medical records you see a long list of anti-depressants: sporadic correspondence from psychologists/psychiatrist which start out optimistic and then segue into frustrated pessimism. These poor people find it so hard to change because every day they see and do the same things. As one person was heard to say: the definition of insanity is when you keep doing the same thing and expect a different outcome.

But the family Doctor is one person who can play a big part in their lives. These people attend our surgeries on a very regular basis. There is one treatment that we can give them which I suspect is one thing that they never get anywhere else - SELF RESPECT

Here's my suggestion: find time to tell these lost and damaged souls that they are worthy of our time, they do have value and they should learn to respect themselves even when other idiots try to put them down. I challenge some patients to do just one simple act - lift their heads and look up. Instead of seeing the rubbish and detroitus on the pavement, they'll see some trees, see the sky and maybe even hear a bird sing. It's only one little thing but if they persist it will become a habit .... a habit of looking for HOPE. And dear God, some of these people need that in their messed up lives.

Thursday, January 21, 2016

We use it every day as soon as we get out of bed, and in fact many people use it when they're asleep too. It's one of the most neglected muscles in our body but when it fails to do it's job properly it can make our lives a misery!

I'm talking about the Pelvic Floor.

The pelvic floor is a sheet of muscles that support all the contents of our pelvis: which means -

The bladder

The rectum and it's faecal contents

and in women, the uterus and ovaries too

When the pelvic floor lets you down then controlling your urine can be a challenge when coughing, sneezing, straining or even just standing up! For those with loose bowel motions, a weak pelvic floor means that soiling your pants can be an embarrassing problem which may lead to social isolation as well. And when the bottom literally falls out of your pelvic floor, your uterus will often fall out too leading to a utero-vaginal prolapse!

Most of these condition are preventable by good personal care. For most people this means a lifelong approach to daily pelvic floor exercises and being aware of:

Avoiding constipation and/or straining with a bowel motion

Avoiding persistent heavy lifting

Treating chronic coughs and straining

Watching your weight and losing it if you're too heavy

So how can I improve the strength of my pelvic floor?

The first thing to do is to identify which muscles they are. After all, if you haven't used them for decades it's highly unlikely you know where they are in the first place! My suggestion is that the next time you go to the toilet to pass urine, try to stop mid-stream. When you do that, you're using your pelvic floor muscles and they are th emuscles you need to focus on.

Squeeze and hold for 5 seconds and then relax - don't forget to include the muscles around your back passage too! Repeat for 5 slow squeezes and try to repeat three or four times a day. It's that simple and you can literally do these exercises anywhere and no-one will know what you're doing!

If you keep this up then after a few weeks you'll be aware that control of your urine will improve. And for ladies, as your pelvic floor muscles get stronger you'll be able to squeeze your vagina as well which brings me to the bit about your sex life .....

Saturday, January 9, 2016

As you may know, I took a few years off from clinical medicine as the emotional strain from caring for patients was hard enough, but running a practice was even harder! Now I've chosen to return to Family Medicine, but this time as a Locum GP, and I've chosen to help patients in the rural community. And it's been great!

Firstly, country people are different and have different problems. They're different in that they're more 'forgiving' and they're more thankful: I had four 'Thank You' cards from one practice after just one three week Locum! But they face their own challenges too. Obesity is a big issue - excuse the pun - and is only compounded by the sense of inertia that occurs in small country towns. With the obesity of course comes Type II Diabetes with all it's insidious complications.

Then there's a big issue with Chronic Pain Syndromes and the use of powerful analgesics that are being used to control them. It's a real challenge in such a short period of time to educate such patients on pain modulation, alternative treatments and the ancillary lifestyle modifications availabe. The resources needed are limited - professionals such as myself, clinical Psychologists and dieticians are nearly all FIFOs which makes continuity of care a real challenge.

And that leads to the one constant gripe of so many rural patients - with the inevitable question being asked "How long are you here for?" They feel that they are constantly having to repeat their stories to new faces (and despite computerised medical records, getting up to speed in 15 minutes in a complicated history is a tough gig even for someone with years of experience) and many patients have literally given up trying merely limiting their consultations to requests for 'a new script'!

Our full time GP colleagues are bearing an enormous load in very isolating circumstances. I can fully understand why a female GP graduate with a young family would find it daunting to embark on a career in a remote rural practice. She would face so many professional and domestic stresses for which there are few practical answers. One may be to utilise the skills, knowledge and experience of those retired GPs who are looking for that something extra in life rather than playing bowls or embarking on another cruise, and developing an efficient, effective mentoring service!

Another would be to support groups such as the Australian Doctors Spouse Network that's been established to support Fellowship spouses in their un-ending merry-go-round of moving from hospital to hospital over their 6 to 10 year training. This group are aware of the challenges their partners face - perhaps Rural GPs Spouses can work with them to build support for their craft too.

Because at the end of the day, we're there to supply Health and Wellness information to our patients. We're there to support our patients when they're struggling. We're there to be their advocate when they have nowhere else to turn and to constantly remind them how special they are and why health is such a valuable commodity.

At the end of the day it's all about our patients, and we can't do that properly unless we look after our Rural Doctors too.